MEDICARE: RACHEL DOHERTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1821529538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DOHERTY

Provider Business Mailing Address
First Line	:	19425 SOLEDAD CANYON RD # 193
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91351-2632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19425 SOLEDAD CANYON RD # 193
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91351-2632
Country	:	US
Telephone Number	:	661-904-7920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	01/21/2022

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Directions to “ RACHEL DOHERTY ” Practice Location

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